Feb. 12, 2013
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Pope Benedict XVI announced Monday that he will resign Feb. 28. / AP

by Janice Lloyd, USA TODAY

by Janice Lloyd, USA TODAY

A day after Pope Benedict XVI announced he was resigning because he wasn't strong enough to fulfill his responsibilities, the Vatican said he had a pacemaker implanted several years before he became pope and the battery was replaced several months ago.

His need for the implant could be one reason for his fatigue, health experts say. Heart disease is the No. 1 killer of men and women.

Pacemakers control abnormal heart rhythms - called arrhythmias - by sending electrical impulses to the heart. They can also be used to treat congestive heart failure, which is characterized by shortness of breath and fatigue. The pope is 85, and he has served for eight years.

"After the age of 70, there are significant problems each year with a number of different rhythm disorders in the heart,'' says Mariell Jessup, a cardiologist at the University of Pennsylvania and president-elect of the American Heart Association. "Sometimes the heart rate is too slow. His pace might have been too slow. It's a very common thing for people in his age group."

Health experts on aging admired his decision to resign, citing visible clues about his declining health and respecting his honesty about an inability to fulfill responsibilities as he grows older.

The Vatican stressed Monday that no specific condition caused the pope to resign, but he has been caught napping while attending services, was told to cut back on his foreign travel and has needed assistance walking. He goes to and from the altar in St. Peter's Basilica on a moving platform to spare him the long walk down the aisle. Occasionally he uses a cane.

Walking is a "powerful indicator of vigor and frailty,'' says Stephanie Studenski, director of research in the division of geriatric medicine at the University of Pittsburgh. "My sense is that he is having a lot of difficulty walking. The brain, the spinal cord, the nerves, the heart, muscles and bones are all needed to walk well."

Her research has found faster walking is associated with longer survival among older adults and has been shown to reflect health and function.

The pope's 89-year-old brother, Georg Ratzinger, told the Associated Press: "His age is weighing on him. At this age, my brother wants to rest more."

But no one should jump to the assumption that everyone in his 80s wants to rest more or should step down from responsibilities.

"I've seen plenty of men, who in their 80s and 90s, if they're fit, they go on and on, and are practically immortal until they start to have a problem,'' says Thomas Perls, professor of medicine at Boston Medical Center.

Perls says geriatricians would have examined the pope to see "if there is any reversible process for the problems. If he is experiencing such frailty and heart difficulties that can't be reversed, it doesn't bode well for his future.''

Jessup cited reports saying the the pope has had several strokes, which can lead to dementia. The most common cause for strokes, she says, is high blood pressure.

"All of these problems can come as we get older,'' she says.

Recognizing frailty as we age is a big step, Studenski says.

"We'd all like to remain vigorous, but the fact is many people confront health problems in late life,'' she says. "I think it is respectful and brave to be honest about oneself and what one can do. It is a gift to others to be able to do that. "

Benedict said he would serve the church for the remainder of his days "through a life dedicated to prayer" and said he is resigning "for the life of the church."

Moving into a new role sets up a model of grace for others to follow, says Toni Miles, director of the institute of gerontology at the University of Georgia in Athens.

"We're all living a lot longer,'' Miles says. "My first thought about the pope was I really admire what he's doing. He's saying, 'I can't handle my job anymore.' He is saying he wants someone else to help solve today's problems. That is something more of us need to learn to do."